<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601778
Report Date: 07/09/2021
Date Signed: 07/09/2021 04:51:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:BROOKDALE UPTOWN WHITTIERFACILITY NUMBER:
198601778
ADMINISTRATOR:MAGPAY, PRECIOSA (SUZIE)FACILITY TYPE:
740
ADDRESS:13250 E PHILADELPHIA STTELEPHONE:
(562) 945-3904
CITY:WHITTIERSTATE: CAZIP CODE:
90601
CAPACITY:280CENSUS: 111DATE:
07/09/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Suzie Mgpayo- AdministratorTIME COMPLETED:
12:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Christine Wong conducted an annual required visit. LPA met with Maintenance Director Jonathan Renojo and explained the reason for the visit. Shortly after, the administrator Suzie Magpayo arrived and assisted with the visit. LPA used the infection control tool to evaluate the facility. LPA observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility has submitted a mitigation plan and approved on 04/03/21,

The facility is located at the city downtown area. The facility building consists of four (4) floors. LPA inspected dining area, lobby area, activity room and room#105, #106, #108, #207, #241, #245, #301, #303, #343, #416, #419 and #423. Each resident's apartment/bedroom has required furniture, linen, sufficient closet space, dresser and lighting. Each bathroom has required grab bars and non-skid mats in the shower and near the toilet. The hot water temperature was measured at each bathroom from 107.6 and 119.1 and met Title 22 regulations. There is a signal/call system in each resident apartment and it is functioning properly. The facility kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days perishable and one week (7 days) of non- perishables. Smoke detectors were tested and most were functioning properly. Carbon monoxide detectors were observed and tested.

LPA's reviewed 10 resident files to confirm emergency contact is updated. LPA's also reviewed staff files to confirm health screenings and fingerprint clearances and they all have required documents in file. LPA's reviewed 10 residents' medication and are centrally stored, locked and the records are current.

No deficiencies issued under California Code of Regulations of Regulations Title 22.

Exit interview conducted and the copy of the report was provided to Suzie Mgpayo

SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1